• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.639-643
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• 2010

Purpose: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. Methods: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. Results: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. Conclusion: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

• Journal of Chest Surgery
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• v.29 no.1
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• pp.14-23
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• 1996

Circulatory arrest under deep hypothermia is an important auxiliary means for cardiac surgery, especially useful in pediatric patients. However, its clinical safety, particularly with regard to the neurologic outcome after long duration of circulatory arrest, is still not established. This study is a review of the eight years'clinical experience of hypothermic circulatory arrest at the Seoul national University Children's Hospital. During an eight-year period from January 1986 through December 1993, a total of 589 consecutive cardiac operations were done using circulatory arrest under deep hypothermia. Among them, 434 consecutive patients, in whom the duration of arrest was 20 minutes or more, are the subject of this study. The duration of arrest ranged from 20 minutes to 82 minutes (mean = 38.7 minutes) under rectal temperature in the range from 12.5$^{\circ}C$ to 25.8$^{\circ}C$. Early neurologic abnormalities occurred in 47 patients : seizure attacks in 28 patients, motor paralyses with or w thout seizure in 12, blindness in 2, and no recovery of consciousness in 5 patients. The rate of incidence of early neurologic abnormalities was calculated at 15.7%. 25 patients showed late neuropsychologic sequelae, such as motor paralysis (9 patients), recurrent seizures (6), developmental delay (8), and definitely low intelligence (2). The rate of incidence of late neurologic sequelae was 8.5%, By statistical analysis, the following factors were identified as the risk factors for post-arrest neurologic abnormalities ; 1) long duration of circulatory arrest, 2) lower-than-ideal body weight, 3) preexisting neurological abnormalities, 4) associated non-cardiovascular congenital anouialies, and 5) low blood pressure during the early post-arrest period. It is concluded that circulatory arrest under deep hypothermia is a relatively safe means for pediatric cardiac surgery with acceptable risk. However, to warrant maximal safety, it is desirable to limit the duration of arrest to less th n 40 minutes. In addition, it is our contention that the early post-arrest period is a very critical period during which maintenance of adequate perfusion pressure in important for the neurologic outcome.

• Journal of Trauma and Injury
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• v.27 no.1
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• pp.1-4
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• 2014

Occipito-atlanto-axial subluxation is a type of high cervical injury. Misdiagnosis of this instability might cause several complications, including neurologic deficits. A radiologic evaluation must be performed and specific parameters that imply cervical instability must be confirmed. Full understanding of these parameters may prevent not only delayed diagnosis but also unexpected complication. We report a case of delayed detection of a cervical instability and emphasize the role of proper diagnosis.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.655-658
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• 2016

Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery.

• The Korean Journal of Pain
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• v.25 no.4
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• pp.262-266
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• 2012

Several complications are possible after a lumbar epidural block. However pneumocephalus are rare. In this case, we report a case of pneumocephalus. A 68-year-old male patient received lumbar epidural block with the loss of resistance technique using air, and after 35 minutes, apnea, unconsciousness, hypotension, and bradycardia occurred. Immediately, brain CT was done, and we found pneumocephalus. The patient complained of severe occipital headache and itchiness due to pneumocehalus. After conservative treatment, the patient recovered without neurologic complications, and on the seventh day of his hospitalization, he was discharged from the hospital.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.275-278
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• 1996

The placement of epidural catheter may cause complications such as epidural hematoma, epidural abscess and neural damage. Among the above complications, epidural abscess is a rare but serious complication. This report pertains to a diabetic metlitus patient who developed spinal epidural and subdural abscess after continuous epidural catheterization for management of pain caused by reflex sympathetic dystrophy. The patient experienced urinary incontinence, as a neurologic sign, 8 days after epidural catherization. In was considered that the poor prognosis was due to a combination effects of a delayed visit to the hospital for treatment, rapid progression of abscess and uncontrolled blood sugar level. We therefore recommend aseptic technique and proper control of blood sugar level to prevent infection during and after epidural catheterization for diabetic patients. Early diagnosis of epidural abscess following surgical procedure must be required to avoid sequelae.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.296-300
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• 1997

Continuous epidural analgesia has been used widely for treatment of acute abdominal postoperative pain. Neurologic complications related to epidural analgesia occur infrequently but may be caused by various chemical, mechanical, ischemic or idiopathic factors. We report a case of abdominal hysterectomy in which unilateral lower extremity paralysis occurred after continuous epidural analgesia.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.176-180
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• 2005

The Outerbridge-Kashiwagi (O-K) procedure is one of popular procedures for the treatment of osteoarthritis of the elbow. Although reliable outcome has been reported in the literature, intraoperative and postoperative complications may occur. Acute postoperative neurologic complications are rarely reported in the literature. We report a case of acute complete ulnar neuropathy following O-K procedure in the elbow with longstanding flexion loss. Prophylactic ulnar nerve decompression during the O-K procedure should be considered in the elbows with osteoarthritis and prolonged severe flexion contracture.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.97-101
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• 1983

The steadily increasing number of operations performed on the heart has given rise to occasional complications involving the nervous system, and this has been interested to cardiac surgeons and neurologists. This survey has been carried out on all Gases submitted to open heart surgery at Seoul National University Hospital during 1982 to determine which operative features were associated with the occurrence of neurological damage. 514 subjects were studied and neurological damage was noted in twenty-five patients [4.9%]. Eight of these 25 patients died in the postoperative period, but neurological damage contributed to the fatal outcome in six cases. Remaining seventeen patients were discharged without problems except one Cortical blindness and one hemiplegic patients who were survived without other problems . A number of features were found to be related to the development of neurological damage, which were age, duration of perfusion, nature of operation, cardiac rhythm and presence of the thrombi or calcification and hypothermic arrest. But many unknown etiological factors are remained out of our sight. A significant increase in the incidence of neurological damage was shown in older age group [13.3% in over 40 year of age], and also the duration of the bypass was associated with subsequent neurological injury especially more than 120 minutes [11.6%]. The presence of atrial fibrillation with intracardiac thrombi or calcification was also a contributing factor to developing neurological complication [16.7%]. These factors were regarded to influence the postoperative neurological complications and more effective method for prevention of these neurologic complication should be studied.

• Journal of Korean Neurosurgical Society
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• v.52 no.1
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• pp.21-26
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• 2012

Objective : To evaluate a new posterior atlantoaxial fixation technique using a nitinol shape memory loop as a simple method that avoids the risk of vertebral artery or nerve injury. Methods : We retrospectively evaluated 14 patients with atlantoaxial instability who had undergone posterior C1-2 fusion using a nitinol shape memory loop. The success of fusion was determined clinically and radiologically. We reviewed patients' neurologic outcomes, neck disability index (NDI), solid bone fusion on cervical spine films, changes in posterior atlantodental interval (PADI), and surgical complications. Results : Solid bone fusion was documented radiologically in all cases, and PADI increased after surgery (p<0.05). All patients remained neurologically intact and showed improvement in NDI score (p<0.05). There were no surgical complications such as neural tissue or vertebral artery injury or instrument failure in the follow-up period. Conclusion : Posterior C1-2 fixation with a nitinol shape memory loop is a simple, less technically demanding method compared to the conventional technique and may avoid the instrument-related complications of posterior C1-2 screw and rod fixation. We introduce this technique as one of the treatment options for atlantoaxial instability.